New information-sharing paradigms that directly benefit patient care are emerging as the largest modular phase-in of EMR continues in Family Medicine, one of JUP’s Beta Test departments since January. While the entire department has access to either one or two EMR modules, eight of the department’s 67 physicians consistently use e-Prescribing in addition to View and Data Entry. The department’s “early adopters” are reporting improvements in clinical-setting performance efficiencies that directly enhance the patient experience -- and one of them, Dr. Richard Wender, chairman of the Department of Family & Community Medicine, is eager to realize even more patient advantages as the three EMR modules are integrated into the clinical routine for all of the department’s practitioners.

Putting Patient Information Together Faster, Before the Exam

“I am always seeing someone else’s patient,” said Dr. Christine Jerpbak, whose practice schedule is four hours per day, three days a week. “EMR helps me put patient information together faster and more efficiently. For example, I might see that the patient saw a family practitioner three weeks ago for something related to today’s visit. I can very quickly see the other physician’s consult notes and treatment plan along with any test results,” said Dr. Jerpbak. She not only credits EMR as helping her to quickly review a patient’s medical history, but also to see what appointments have been scheduled. “A patient came in for a check up and a complaint of knee pain. I saw she had recently had an x-ray and scheduled an appointment to see a rheumatologist in six weeks. During her exam, I reviewed that x-ray, diagnosed arthritis and prescribed a course of treatment for pain. The patient didn’t have to wait six weeks to find out about her arthritis,” said Dr. Jerpbak. “In reviewing another patient’s record before she walked in the [exam room] door, I saw she had a blood test that morning. She was really impressed that I was able to immediately review the lab results with her.

Improving Patient Safety

Noting the large number of medications taken by some patients, Dr. Victor Diaz, the department’s assistant medical director, appreciates the patient safety benefits of EMR’s e-Prescribe module. “Our medical assistants entered all of our patients’ medications into their EMRs so we could view them electronically,” said Dr. Diaz. “EMR helps me check that two doctors aren’t prescribing the same type of medication and it provides a double check against interactions between medications.” In addition, he described EMR’s database of medications as “an additional tool that can help expand a practitioner’s knowledge about the available medications that can be used to treat a condition.”

“The ability to have greater clarity on patient medication is hugely important,” said Dr. Wender who now provides his patients with a print out of their current medications at the end of each office visit. Dr. Wender also noted that in addition to medications, Family Medicine enters into EMR current data about each patient’s alcohol, tobacco, allergies, and family history.

Indirect Physician-to-Physician Communication

“Patients aren’t always the best historians,” said Dr. Diaz who uses EMR to quickly and easily refer to progress notes and recommendations from specialists as treats his patients. “The fact that we [physicians] can actually communicate between departments is going to be huge as the rollout of EMR continues.”

Dr. Wender recently treated a patient who discussed a recent operation but was unable to express herself clearly about what the surgeon had found. While in the exam room “I was able to bring up the op note and then see exactly what she was talking about,” said Dr. Wender.

Dr. Jerpbak said, “EMR is a great way for physicians to indirectly communicate [with each other] about a patient.” She noted that Jefferson medical students, who have view-only access to EMR “catch on very fast. They can look at the EMR beforehand and go into the exam room with more knowledge about the patient who is walking in the door.”

Improving Efficiency in Clinical Practice

Even at this early stage of rollout, EMR is bringing many time efficiencies into Family Medicine’s practices. Automatic reminders appear as practitioners enter data into patient records; and personalized ‘favorites’ menu allows them to see the list of medicines they most frequently prescribe for a diagnosis. EMR is also used at the front desk by staff members who enter the arrival time of each patient. As a result, any physician or staff member can look on their computer to see the number and names of patients currently in the waiting room.

Apart from these practice-benefitting features Dr. Diaz said, “I love the fact that I can prescribe through EMR. I can go from the patient’s list of medications and reformat them as prescriptions and send them electronically to the patient’s pharmacy. It’s fantastic when I send off a prescription and [at the end of the exam] the patient asks, ‘where’s my script?”” Practitioners find that e-Prescribing is not only time efficient for new prescriptions, but also that refills can be ordered with one click.

“Most delightful of all, with EMR we never have an office visit where we have to look for a chart,” said Dr. Wender. As a result, the time physicians spend with patients is more productive because of EMR. Echoing this sentiment, Dr. Jerpbak said, “In the past, I had to leave the exam room to look something up or find a chart or get some correspondence or ask someone to find something. Now, I have all the information I need and don’t have to leave the exam room when I’m with a patient. It’s wonderful.”

Department Goal: 100% Trained, Uniformity of Use

As of July, three EMR modules, View, Data Entry and e-Prescribing, are in various levels of use by Family Medicine. The department is now focused on having every physician and nurse practitioner trained and using the modules uniformly. “We want everyone following our work flow plan for EMR: every time, every patient.” said Dr. Wender who stressed training as paramount to success. “We’re getting [individualized] help for those people who may not be as technology-minded as others. We know they don’t want to slow down their schedules [during their learning curves].”

Dr. James Studdiford benefitted from classroom and one-on-one training to learn the first two modules of EMR, is in the process of learning e-Prescribing, and has already registered to learn Tasking, the department’s next-scheduled module. Describing his introduction to EMR, Dr. Studdiford said, “It was a quantum leap. It took me a while to get a feel for it, but I caught on to its method of thinking and categorizing. Once I saw the potential and understood the simplicity of entering the patient history and medications, I got a kick out of using it.” Dr. Studdiford anticipates he will take advantage of EMR tutoring after his classroom training as new modules are added.

After using two EMR modules for several months, Dr. Studdiford moved to a practice that uses only one -- a “view-only” environment. “It was an adjustment but I got over it pretty quickly,” said Dr. Studdiford. Looking forward to the department’s expansion of EMR use he said, “EMR is here to stay. It’s part and parcel of where medicine is going in 50 states. I don’t want to be left out of the loop.”

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